A review of the management of diseases of the Bartholin's gland.

Bartholin's abscess and cyst account for 2% of all gynaecological visits per annum. This article reviews the anatomy, epidemiology and pathophysiology of the Bartholin's gland. The management of Bartholin's abscess including antibiotic use in the early stage of the condition together with options for surgical intervention are discussed and in so doing the variation of clinical practice in other countries is considered. The use of the word catheter, carbon dioxide laser are compared with traditional surgical techniques of incision and drainage and marsupialisation. The outcomes of treatment particularly the high recurrence rate (2-25%) and the associated morbidity are reviewed. Finally the issue of cancerous pathology as an aetiology is highlighted in the postmenopausal age group.

Endometrial ablation with the Cavaterm thermal balloon.

This prospective observational study evaluates the efficacy and safety of thermal Balloon endometrial ablation using the Cavaterm system for the treatment of dysfunctional uterine bleeding. Seventy-seven women with a mean age of 43 years who met the inclusion and exclusion criteria were treated under general anaesthesia. A 9-mm diameter catheter with a silicone balloon at its tip was inserted transcervically into the uterus and was inflated with sterile 1.5% glycine and connected to a control unit that maintained the temperature of the circulating heated fluid at 75 degrees C, monitored the pressure and terminated the treatment after 15 minutes. There were no intra-operative complications and patients tolerated the treatment well. Satisfaction rates were 90% at both 12 and 24 months. At 24 months 10% of patients had heavy periods, 5% normal periods, 39% light periods and 46% amenorrhoea. Cavaterm balloon ablation seems a safe and effective option for women with menorrhagia. The procedure does not require additional training and expertise in operative hysteroscopy and compares favourably with established techniques.

A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo-oophorectomy.

OBJECTIVE: To identify differences in the peri-operative outcome of women undergoing hysterectomy with bilateral salpingo-oophorectomy performed either by abdominal hysterectomy and bilateral salpingo-oophorectomy or by laparoscopic-assisted salpingo-oophorectomy and vaginal hysterectomy. To identify any potential management implications, including financial differences, between these two forms of operations. SUBJECTS AND METHODS: Eighty women undergoing hysterectomy and bilateral salpingo-oophorectomy for benign gynaecological conditions were prospectively randomised to have the procedure by laparoscopic-assisted bilateral salpingo-oophorectomy and vaginal hysterectomy or total abdominal hysterectomy and bilateral salpingo-oophorectomy. The peri-operative and post-operative courses of both groups were compared. RESULTS: Although laparoscopic-assisted bilateral salpingo-oophorectomy and vaginal hysterectomy took longer (100 (SD 5.6) versus 57 (SD 4.7) min, P < 0.0001), the women undergoing this procedure had a shorter time in hospital (3.5 versus six days, P < 0.0001) quicker recovery (three versus six weeks, P < 0.0001) and returned to work earlier. There were minimal complications in both groups and they were not significantly different. The cost of the laparoscopic-assisted procedure was greater during the operation with longer operating time and cost of disposable instruments. However, the total cost of treatment was less in this group because of shortened post-operative stay. CONCLUSION: The study shows laparoscopic-assisted bilateral salpingo-oophorectomy and vaginal hysterectomy is a safe and cost-effective procedure for women requiring a hysterectomy and bilateral salpingo-oophorectomy.

Laparoscopic-assisted vaginal hysterectomy with bilateral oophorectomy versus total abdominal hysterectomy and bilateral salpingo-oophorectomy--implications for gynecologic practice in the United Kingdom.

A prospective, randomized study was conducted to identify differences in the perioperative outcome of patients undergoing either routine total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) or laparoscopic-assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (LAVH-BSO). We also assessed potential management implications, including financial differences, between the operations. Of 40 women requiring hysterectomy for a range of benign conditions, 20 underwent LAVH-BSO and 20 TAH-BSO. The respective mean operating times were 97.5 and 54 minutes. Patients in the former group required significantly less postoperative oral analgesia, 4.1 doses compared with 11.7 doses on average. The length of postoperative stay was shortened from 6 to 3.8 days on average for LAVH-BSO. The potential cost savings was 17.9% per case for LAVH-BSO compared with TAH-BSO. Thus, LAVH-BSO was a safe alternative to TAH-BSO, with less morbidity and earlier hospital discharge. Possible cost savings suggest the need for changes to current operating and inpatient hospital resources.

The mental health visitor and psychiatric after-care.

The results of a project, originating in South Australia, designed to assist the discharge of psychiatric patients are described. The project introduced a new category of mental health worker, the mental health visitor. These mature-age "subprofessionals" attached to social work departments after a brief, specific, in-service training, have worked closely with Mental Health Services psychiatrists, psychologists and social workers in various situations. They have established good relationships with social workers in other agencies and with general practitioners and their activities have included initial assessment, liaison and after-care. The demand for them appears to be increasing.